Overpayment and underpayment audit findings

Sec. 8. An audit finding of an overpayment or underpayment of a claim: (1) must be based on an actual overpayment or underpayment; and (2) may not be based on a projection that is based on the number of: (A) patients who: (i) have similar diagnoses; and (ii) are served by the pharmacy; or (B) prescriptions for or refills of similar legend drugs that are dispensed by the pharmacy. As added by P.L.7-2009, SEC.1.